Wagner, Susan Katali

Wagner, Susan Katali is an individual health care provider with primary practice located at 6926 Brockton Ave Ste 9, Riverside CA 92506-3800. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / General Care, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is her primary health care specialty. Wagner, Susan Katali can be contacted via phone (951) 788-0370.

Contact Information

Primary practice address
6926 Brockton Ave Ste 9 Riverside CA 92506-3800
Phone: (951) 788-0370
Fax: (951) 788-0390
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / General Care 2278G1100X RCP19999 California
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA16194 California

Profile Details

NPI number 1457544983
LBN Legal business name Wagner, Susan Katali
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 17th, 2007
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457544983 NPPES
California Other PA16194 STATE
California Other 1034312 STATE

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